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Treatments and drugs
By Mayo Clinic staffObsessive-compulsive disorder treatment can be difficult, and treatment may not result in a cure. You may need treatment for the rest of your life. However, OCD treatment can help you bring symptoms under control so that they don't rule your daily life.
Main obsessive-compulsive disorder treatments
The two main treatments for obsessive-compulsive disorder are:
- Psychotherapy
- Medications
Which option is best for you depends on your personal situation and preferences. Often, treatment is most effective with a combination of medications and psychotherapy.
Psychotherapy for obsessive-compulsive disorder
A type of therapy called cognitive behavioral therapy (CBT) can be effective. Cognitive behavioral therapy involves retraining your thought patterns and routines so that compulsive behaviors are no longer necessary.
One CBT approach in particular is called exposure and response prevention. This therapy involves gradually exposing you to a feared object or obsession, such as dirt, and teaching you healthy ways to cope with your anxiety. Learning the techniques and new thought patterns takes effort and practice. But you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.
Therapy may take place in individual, family or group sessions.
Medications for obsessive-compulsive disorder
Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first. Antidepressants may be helpful for OCD because they may help increase levels of serotonin, which may be lacking when you have OCD.
Antidepressants that have been specifically approved by the Food and Drug Administration (FDA) to treat OCD include:
- Clomipramine (Anafranil)
- Fluvoxamine (Luvox)
- Fluoxetine (Prozac)
- Paroxetine (Paxil, Pexeva)
- Sertraline (Zoloft)
However, many other antidepressants and other psychiatric medications on the market also may be used to treat OCD off-label. Off-label use is a common and legal practice of using a medication to treat a condition not specifically listed on its prescribing label as an FDA-approved use.
Choosing a medication
In general, the goal of OCD treatment with medications is to effectively control signs and symptoms at the lowest possible dosage. Which medication is best for you depends on your own individual situation. It can take weeks to months after starting a medication to notice an improvement in your symptoms.
With obsessive-compulsive disorder, it's not unusual to have to try several medications before finding one that works well to control your symptoms. Your doctor also might recommend combining medications, such as antidepressants and antipsychotic medications, to make them more effective in controlling your symptoms.
Don't stop taking your medication without talking to your doctor, even if you're feeling better. You may have a relapse of OCD symptoms if you stop taking your medication. Also, some medication needs to be tapered off, rather than stopped abruptly, to avoid withdrawal symptoms.
Medication may be continued for one to two years before your doctor will try to gradually taper your dosage. If your symptoms return on a lower dose, you may need to take medication indefinitely.
Medication side effects and risks
All psychiatric medications have side effects, such as stomach upset, sleep disturbance, sweating and reduced interest in sexual activity. Be sure to talk to your doctor about all of the possible side effects and about any health monitoring that's necessary while taking psychiatric medications, especially antipsychotic medications. And, be sure to let your doctor know if your medication is causing troubling side effects.
Some medications can have dangerous interactions with other medications, foods or other substances. Tell your doctors about all medications and over-the-counter substances you take, including vitamins, minerals and herbal supplements.
Other treatment options
Sometimes, medications and psychotherapy aren't effective enough in controlling your OCD symptoms. In rare cases, other treatment options may include:
- Psychiatric hospitalization
- Residential treatment
- Electroconvulsive therapy (ECT)
- Transcranial magnetic stimulation
- Deep brain stimulation
Because these treatments haven't been thoroughly tested for use in obsessive-compulsive disorder, make sure you understand all the pros and cons and possible health risks.
- Obsessive-compulsive disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Oct. 4, 2010.
- Ciechanowski P, et al. Overview of obsessive-compulsive disorder. http://www.uptodate.com/home/index.html. Accessed Sept. 29, 2010.
- Hewlett WA. Obsessive-compulsive disorder. In: Ebert MH, et al. Current Diagnosis & Treatment: Psychiatry. 2nd ed. New York, N.Y.: McGraw Hill Companies, Inc.; 2008. http://www.accessmedicine.com/content.aspx?aID=3286970. Accessed Oct. 4, 2010.
- Practice guideline for the treatment of patients with obsessive-compulsive disorder. Arlington, Va.: American Psychiatric Association. http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm. Accessed Oct. 5, 2010.
- Stein DJ, et al. Obsessive-compulsive disorder: Diagnostic and treatment issues. Psychiatric Clinics of North America. 2009;32:665.
- Ward HE, et al. Update on deep brain stimulation for neuropsychiatric disorders. Neurobiology of Disease. 2010;38:346.
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